Reversible Magnetic Resonance Imaging Abnormality in A Case of Diabetic Hyperglycemia related Epilepsia Partialis Continua

Seizure can be the first symptom of diabetic hyperglycemia and cause transient abnormalities in neuroimaging studies. Herein, we report the case of a 72-year-old woman with a one-month history of intermittent clonic movement of the left upper limb and neck. Laboratory testing revealed non-ketotic hyperglycemia. Electroencephalography showed asymmetrical background with delta activity over right frontal-temporal lobe. Brain magnetic resonance imaging revealed leptomeningeal and cortical enhancement in the right parieto-occipital area with T2 hypointensity in the corresponding subcortical area, a finding which has been rarely reported. She was treated successfully with oral hypoglycemic agents and short-term use of valproic acid. Follow-up brain magnetic resonance imaging three months later showed total recovery of the signal changes with residual mild cortical atrophy in the same region. For patients with diabetic hyperglycemia and prolonged seizures which results in abnormalities of brain imaging consistent with leptomeningeal and cortical enhancement, valproic acid may be beneficial in abolishing the seizures. (J Intern Med Taiwan 2011; 22: 438-443)